Artificial Heart and Heart Transplant

Heart disease is rapidly becoming a major health concern in our country. What is alarming is that many of these patients are young and are first diagnosed in advanced and terminal stages of the disease, with heart failure. Heart failureis a stage wherein the heart can't function adequately to meet the demands of the body. The patient feels tired, breathless and his body swells up with fluid accumulation. These patients can be managed with medications for some time. However, in the terminal stages, the medications lose their efficacy and the patient finds it difficult to even speak a few words, walk a few steps or lie down flat.

However, there is hope for such patients. The gold standard in treatment for such patients is Heart Transplantation. The source for a heart is a brain-dead patient, i.e., a patient in the coma who has no chance of recovering. If the heart in such a patient is normal and functioning, it can be harvested and transplanted to a patient with terminal heart failure. These patients can recover fully and get back to a normal life. NH Health City, Bangalore is one of the very few centres in the country with an active transplant program.

For patients who are in direct need of a heart transplant and no organ is available, mechanical pumping devices called Ventricular Assist devices or Artificial Hearts are available. These are small pumps which are implanted inside the body, which take over the function of the heart. They run on small 12 volt rechargeable batteries. These batteries and a small controller are situated outside the body and are connected to the pump inside by a small cable that passes through the skin above the umbilicus. They can be left in place until an organ is available for transplant. With technological advancements, the devices currently available are compact, efficient, reliable and very long lasting. They can now be used as alternatives to transplant!

A patient has to be first evaluated to assess the suitability for undergoing an artificial heart implantation. After the surgery, these patients can return to full active life, with very few limitations. Narayana Health has the credit of being the first Hospital in entire Asia to have implanted the latest 3rd generation device for the first time in 2008.

Heart Transplant Surgery Procedure

The heart transplant or cardiac transplantation surgery is an open-heart procedure that might take several hours depending on the complexity of the case and if other surgeries are required. For patients without a VAD, heart transplant surgery may be completed in approximately three to four hours. But, if the patients have a VAD or had any prior chest surgeries, the process could be complicated and may take six to eight hours.

Before the procedure, patients are given a general anaesthetic to keep them asleep. The surgeons will then connect the patients to a heart-lung bypass machine so that there is no obstruction in the flow of oxygen-rich blood throughout the body.

The surgeon begins by making an incision in the chest. The chest bone is then separated to open the rib cage so that they can operate on the heart. The diseased heart is removed and the donor’s heart is put in its place. The new heart starts beating once the blood flow is restored. Sometimes, an electric shock may be necessary to get the donor heart to beat properly.

Patients commonly feel pain after surgery. Hence, medications are given to control post-surgery pain. Patients will also be kept on a ventilator to help them breathe along with tubes to drain out the fluids from around the lungs and heart. Fluids and medications are administered through IV tubes after the surgery.

Post-Operative Care

After the transplant, the patient stays in the ICU for a few days and is then moved to a regular hospital room. After being discharged from the hospital, the transplant team will monitor the patient at the outpatient transplant centre. The first three months after the transplant are crucial, so people stay close to the transplant centre during the time. Moreover, due to the frequency and intensity of the monitoring, it’s convenient if they are closer.

Patients are also monitored for any symptoms of organ rejection that include fever, fatigue, shortness of breath, weight gain, etc. Therefore, frequent heart biopsies are carried out in the first few months of transplantation when infections or rejections are most likely to occur. During a biopsy, the doctor advances a tube into a vein in the neck or groin and directs it to the heart. A biopsy device directed through the tube removes a tiny sample of heart tissue, which is examined in a lab.

The patient also needs to include many long-term adjustments after the heart transplant.

1. Immunosuppressants: Immunosuppressants are medications that prevent the immune system from attacking the transplanted heart. One has to take these medications for the rest of their lives.

As immunosuppressants decrease the activity of the immune system, the body becomes vulnerable to infection. Therefore, the doctor might also prescribe some antibacterial, antiviral and antifungal medications. The doses and number of drugs can be reduced over time when the risk of rejection decreases.

2. Therapies and care plan for life: Following a heart transplant, it is vital to take medications according to the doctor’s instructions. The doctor will also order some lifestyle changes, such as eating a healthy diet, exercising, avoiding tobacco products, etc.

Regular follow-ups are a part of the life long care plan as well. It is good to keep a list of all the medications handy in case of an emergency medical attention.

3. Cardiac rehabilitation: Cardiac rehab programs offer exercise and education to help people improve their health and get back to their normal lives quicker.

Artificial Heart And Heart Transplant FAQ's

Survival rates of patients with a heart transplant depend on their overall health. If the patient takes proper care and follows a healthy lifestyle then, s/he can survive for up to 10 years or even more in some case. The post-heart transplant lifestyle should include a healthy diet, proper medication (if needed), exercising, and avoiding all hazardous habits such as smoking, and drinking.

A heart transplant procedure is done while the patient is on a heart-lung machine that helps in blood circulation. The heart surgeon will remove the patient’s heart, leave the pulmonary vein and stitches the donor’s heart in. Once the heart starts beating, the patient is removed from the heart-lung machine.

Heart transplant surgery is a crucial procedure done when the heart stops responding to all other treatments causing heart failure. The surgery is done after a lot of preparation and has some potential risks like;

Heart failure can occur due to other conditions or illnesses. One of the most common cause is coronary artery disease. This disorder tightens the arteries that supply blood and oxygen which leads to heart failure. Other reasons can be;

The heart transplant procedure is a complicated surgery that can take up to ten hours to complete. After the surgery, the patient is kept under observation to check if the body is rejecting the new organ. Usually, the patient is kept in the hospital anywhere between one to two weeks. After the discharge as well, the patient is called for constant check-ups and to examine if the heart is functioning fine.